Review article: topical corticosteroids in inflammatory bowel disease

Area of Science:

• Gastroenterology
• Pharmacology
• Inflammation Research

Background:

• Topical corticosteroids are crucial for inflammatory bowel disease (IBD) treatment.
• Traditional corticosteroids like hydrocortisone can cause systemic side-effects due to mucosal absorption or low hepatic metabolism.
• A need exists for IBD treatments with localized action and reduced systemic impact.

Purpose of the Study:

• To review the clinical efficacy and safety of newer topical corticosteroid preparations for IBD.
• To compare the systemic side-effect profiles of novel corticosteroids against older agents.
• To evaluate corticosteroids designed for reduced systemic absorption or increased first-pass metabolism.

Main Methods:

• Literature review of clinical studies on newer topical corticosteroids.
• Analysis of data on mucosal absorption and hepatic metabolism of selected agents.
• Evaluation of reported clinical activity and adverse events associated with these preparations.

Main Results:

• Newer corticosteroids such as fluticasone propionate, beclomethasone dipropionate, and budesonide demonstrate minimal systemic corticosteroid activity.
• Prednisolone metasulphobenzoate and tixocortol pivalate also show reduced systemic effects.
• These newer agents are generally associated with a better safety profile than older topical corticosteroids.

Conclusions:

• Novel topical corticosteroid formulations offer a safer alternative for managing inflammatory bowel disease.
• Preparations like budesonide and fluticasone propionate provide effective local treatment with diminished systemic corticosteroid side-effects.
• The development of corticosteroids with targeted delivery and metabolism is key to improving IBD management.